ACKNOWLEDGEMENT of CANCELLATION POLICY and LIABILITY RELEASE

I certify that the information provided is complete and correct to the best of my knowledge.

Liability Release

I hereby certify that I am voluntarily participating in a physical conditioning and corrective exercise program with Sara C. Berger, NCPT. I hereby affirm that I have my physician's approval, I am in good physical condition, and I do not suffer from any disability that would limit or prevent my participation in this program. After having the opportunity to inquire in detail regarding all aspects of the program and to have had all questions with regard to the program satisfactorily answered, including any
physiological and/or psychological changes which can occur, I certify that I understand the potential risks of the program. I agree to release from all liability and to indemnify Sara C. Berger, NCPT from and against all claims, actions, judgments, costs, expenses, and demands with respect to injury, loss, death or damage to my person or property in connection with my taking part in the above stated program. It is understood and agreed that this agreement is to be binding on myself, my heirs, my executors, administrators, and assigns.

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releases, and, for myself, my heirs, my executors, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law.

I certify that I have read and understood the above. Intending to be legally bound, I hereby make this agreement on